Provider Demographics
NPI:1467691212
Name:BUENOS AIRES DENTAL, INC
Entity Type:Organization
Organization Name:BUENOS AIRES DENTAL, INC
Other - Org Name:LAKE QUALITY DENTAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG (HELENE)
Authorized Official - Middle Name:D
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-255-5538
Mailing Address - Street 1:1503 BUENOS AIRES BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6821
Mailing Address - Country:US
Mailing Address - Phone:352-753-5838
Mailing Address - Fax:352-391-5837
Practice Address - Street 1:1503 BUENOS AIRES BLVD STE 125
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6821
Practice Address - Country:US
Practice Address - Phone:352-753-5838
Practice Address - Fax:352-391-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty